EH 1_2016

Every Heart Speaks Its Own Language. We Understand Them All. The new cardiac remote monitor demonstrates accurate arrhythmia detection and reliable Home Monitoring transmission. BioMonitor 2 Always On www.heart-monitoring.com EUROPEAN HOSPITAL  Vol 25 Issue 1/16 2 NEWS & MANAGEMENT Certainly not from the group of Argentinian doctors who blame a larvicide, Pyriproxyfen, for the rise in microcephaly births. This has been added to people’s water tanks to combat mosquitoes. Although there is said to be no supporting scientific evidence of this cause, and the Health Ministry rejected the ‘non-scientific report, at least one Brazilian state ended distribution. Theories theories … Yoichi Shimatsu a science writer based in Hong Kong has an intrigu- ing belief – that microcephaly cases were caused as a side effect of RIDL gene-transfer. ‘The so-called Death Gene blockage, using the GATA binding protein, can affect the same gene in human embryos as in the targeted mosquito pupae,’ he states. This protein has been introduced into male mosquitoes, which are then released as part of the OX513-A captive mosquito pro- gramme. Out there they successfully mate with wild local female mosqui- toes and the protein enters the eggs to disrupt embyonic growth. The lar- vae self-destruct before adulthood. ‘However,’ writes Shimatsu, ‘these same mother mosquitoes can then transfer the dangerous protein into women, thereby seriously harming human embryonic development of the brain, nerves, heart and testicles. Damage to the GATA-1 protein in human embryos is associated with Down Syndrome, a brain disorder similar to Brazilian microcephaly.’ This population control by gene transfer science is ingenious. The OX513-A is produced by Oxitec Ltd, near Oxford, England. The firm’s description of various mosquito control methods found at http:// www.oxitec.com/health/dengue- information-centre/vector-control/ is a worthwhile read. Environmental issues Amy Y Vittor MD, Assistant Professor of Medicine at the University of Florida’s Emerging Pathogens Institute, studies the interface between vector-borne disease and land use. She is studying another mosquito-borne virus, Madariaga, the cause of many cases of encepha- litis in a Panamanian jungle. Her team examine ‘the association between deforestation, mosquito vector factors, and susceptibility of migrants compared to indigenous people in the affected area’. ‘In our highly interconnected world, which is being subjected to massive ecological change,’ she underlines, ‘we can expect on-going outbreaks of viruses originating in far-flung regions with names we can barely pronounce – yet.’ So, what about deforestation? Resulting landslides of soil enter rivers and so deposit large amounts of mercury, which in water becomes methylmercury, an organic form of mercury – a neurotoxin, easily bio- accumulated in organisms i.e. enter- ing the food chain through fish. Brazil, a meat-eating nation, in recent years encouraged a fish farm- ing industry. Current per capita con- sumption of fish is still low there – 6.8 kg per year. However, campaigns in 2003 focused on national and international markets for Brazilian aquaculture products. Much research shows that farmed fish can be high in methylmercury a known cause of microcephaly. Accidental leaching from aluminium processing might affect the food chain.. Checking for is presence in the microceph- aly inquiry perhaps should not be ignored. Life before ZikaV Sandra da Silva Mattos of the Círculo do Coração de Pernambuco and col- leagues dug into medical records of over 16,000 babies born between 2012 and 2015 at one of 21 medi- cal centres in badly Zika affected Paraíba state. Since 2012, they found a strikingly large number of babies – 4-8% were suspected of micro- cephaly within its broadest defini- tions, and the number peaked in 2014 – before Zika was detected in Brazil. ‘What we expected was that we’d have around three to four cases a year of microcephaly – which has been documented in the official sites,’ Mattos said in an interview. ‘Then we noticed we had much, much higher numbers.’ The researchers then narrowed the definition to extreme microcephaly cases and found the rates – 0.04% to 1.9% levelled to global reports of the condition. Still, hundreds of babies had microcephaly: the nationwide incidence of reported microcephaly in years before 2015 was below 200 annually. ‘It’s possible, she noted, Immigrants could fill medical professional gaps Migration brings opportunity Marco Bünger predicts a shortfall of at least 1,000 to 1,500 medical pro- fessionals per year in Brandenburg State’s healthcare system in the future, based on an analysis of expected employee needs, an on- going drop in numbers complet- ing their education and those retir- ing from medical professions in the State, the second most sparsely populated in Germany (population around 2.46 million). However, the zone contains the State of Berlin at its centre, jointly forming the European Berlin/Brandenburg Metropolitan Region, in which about six million people live. The calculated requirements per- tain to geriatric nurses and other nurses, but occupational therapists and technical medical assistants will also be needed in the future, along with a shortfall in doctors. Some hospitals are already spending up to € 250,000 for headhunters to seek doctors, Bünger notes. Against this background, the busi- ness consultant developed the idea of recruiting the predicted shortfall in medical personnel from incom- ing refugees. This was based on the Swedish model project ‘Nationell Matchning’, which attempts to win back immigrants with an academic background who are working in non-academic professions and place them in academic jobs. Convinced by the idea, the Brandenburg Ministry for Health commissioned a working concept and Bünger developed the programme ‘National Matching’ in collaboration with the Niederlausitz Hospital in South Brandenburg. National Matching begins the pro- cess early – at the initial registra- tion centres – and aims exclusively at refugees with training or prior experience in healthcare. All refu- gees selected for participation in National Matching will be mentored from the initial language course through to starting work – a process that can take between one and a half to six years, depending on the participant’s prior knowledge. The refugees complete a variety of mod- ules in this process, starting with language support, assessment of qualifications, their soft skills, trans- fer or additional qualifications and an introduction to the legal, ethical and medical care principles in the German healthcare system, which is compulsory for all participants. Potential employers are also involved in the programme and Bünger envisages an event where the employers meet participants. Sitting in on lectures and going on excursions to hospitals and out- patient departments aims to pro- mote mutual familiarity. However, this will not be easy. Brandenburg’s rural areas are not exactly known for their open-mind- edness. These have little experience of migrants and, accordingly, are prejudiced and may even exhibit hostility towards foreigners. Bünger plans workshops and seminars with a focus on awareness of different cultural backgrounds to promote greater openness on the part of employers. This is based on strate- gies used in Great Britain and efforts made by the National Health Service (NHS) to integrate ethnic minorities into the healthcare system. Other important aspects of National Matching are an in-depth assessment of specialist knowledge and professional experience, as well as participants’ social competence. This applies to refugees with and without evidence of their qualifi- cations in the form of degrees or work references. Any participating refugees with false documents are rapidly revealed, Bünger says. The comprehensive assessment is also important for other purposes because we cannot even begin to imagine the conditions in which refugees have lived. ‘Does commit- ment mean anything to a refugee from Somalia? Is the refugee able to deal with conflict? We want and need to find out all of this if we want to achieve successful integra- tion,’ Bünger points out. Currently he is testing an IT-based system to evaluate social compe- tence that has already been used in Sweden. He also wants to adopt another of Sweden’s ideas: an investiga- tion there revealed that 98% of the immigrants had a smartphone. As a result, a trial app was introduced in all languages spoken by the refugees. The immigrants can use this to create a professional profile for themselves, provide a personal assessment of their competence and upload certificates and documents. The job centre and educational pro- viders can access their data and thus liaise more rapidly. It remains to be seen whether this can also be imple- mented in Brandenburg. To date, the State uses paper questionnaires for this purpose. The concept of National Matching is unique in Germany, so there is still no coordinating office to oversee the entire process of pro- fessional integration for a specific professional group, from start to fin- ish. Presented to the general public at the beginning of March the pro- gramme will start this spring. Bünger is still seeking a spon- sor. Once found, he hopes to being with 80-100 participants. The first of these could then enter into profes- sional life as 2018 begins, with the majority probably taking four years to do so. Details: Swedish project info (in Swedish): http://www.arbetsformedlingen.se/Om-oss/ Var-verksamhet/Projekt-och-samarbeten/ Projekt/Projektsidor/2012-06-13-Nationell- Matchning---skapar-moten-mellan- utlandska-akademiker-och-arbetsgivare-i- hela-landet.html. Colour-based methods to assess soft skills, developed in the Czech Republic and already employed in Sweden are planned for use in Brandenburg: www. camethod.com A unique pilot project to promote entry into professional life in Germany for refugees with a medical background might counteract the acute shortage of qualified employees in healthcare. The programme is scheduled to start this spring. Our correspondent Bettina Döbereiner interviewed Marco Bünger, initiator of the ‘National Matching’ concept Marco Bünger has been the chief executive of the business consultancy Adler Management Berlin since 2013. Before this, he was chief executive of a regional redevelopment company for the metal and electro-industry (EEPL). Commissioned by the Brandenburg Ministry of Health, he developed the National Matching concept in partnership with the Niederlausitz Hospital. Pan American Health Organization (PAHO) Continued from page 1 The Zika mystery

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